Position Desired:                   Full Time   Part Time                                Date:

WE ARE AN EQUAL OPPORTUNITY EMPLOYER APPLICANT'S STATEMENT I understand that if I am hired, my employment will be for no definite period, regardless of the period of payment of my wages.  I further understand that I have the right to terminate my employment at any time with or without notice, and the University has the same right.  No one other than the President of the University has authority to modify this relationship or make an agreement to the contrary.  Any such modification or agreement must be in writing and signed by the President of the University. I understand that the University reserves the right to require me to submit to a drug test any time and also reserves the right to require me to submit to an alcohol test and/or medical examination to the extent permitted by law.  I authorize the University to investigate my driving record, my criminal record, my credit history, and education history, and I understand that an investigative consumer report may be prepared whereby information is obtained through personal interviews with neighbors, friends and others with whom I am acquainted.  This inquiry would include information as to my character, general reputation, personal characteristics and mode of living.  I understand that I have the right to make a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigation. The contents of any employee handbook or personnel manuals, as well as other Employer policies and practices, are subject to change or modification by the Employer, solely at its discretion, without notice.  I also understand that no supervisor or other official of the Employer (except the President of the University) has the authority to enter in any agreement with me or to make any agreement contrary to the foregoing. I further understand that the University may contact my previous employers and I authorize those employers to disclose to the University all records and other information pertinent to my employment with them.  I also authorize the University to provide truthful information concerning my employment with it to my future prospective employers and I agree to hold it harmless for providing such information. This application will remain active for thirty (30) days.  Any applicant wishing to be considered for employment beyond thirty (30) days should reapply. I certify that all of the information that I provide on this application and in my interview will be true and accurate.  I understand that If I am employed and any such information is later found to be false, incomplete or misleading in any respect, I may be dismissed. DO NOT SIGN UNTIL YOU HAVE READ AND UNDERSTAND THIS STATEMENT              Signature of Applicant                               Date                 (typing your full name and the date indicates acceptance)

Notice to Applicants: This employer complies with the Americans with Disabilities Act of 1990.  During the interview process, you may be asked questions concerning your ability to perform job-related functions.  If you are given a conditional offer of employment, you may be required to complete a post-job offer medical history questionnaire and/or undergo a medical examination.  If required, all entering employees in the same job category will be subject to the same medical questionnaire and/or examination and all information will be kept confidential and in separate files.

Application for Employment
(Valid for only 30 Days)

Please answer all questions.  Resumes are not accepted in lieu of completion of this application.  This application is designed to be used for several types of job positions.  Some questions may not be completely applicable to the job position you are seeking; however, we ask that you answer all questions.

Last Name:   First Name:   Middle Name:   Social Security #

Current Mailing Address:   City:   State:   Zip:  

Telephone: (if none, type "None")   Email: (if none, type "None")

Previous Address:   City:   State:   Zip:  

Position(s) Applying For:

How long have you been a resident in the State of Florida?  years
If you are under 18 years of age, can you provide required proof of your eligibility to work?	Yes  No  N/A
Have you ever filled an application with us before?	Yes  No
Have you ever been employed with us before? (If yes, give dates of employment)	Yes  No
Are you currently employed?	Yes  No
May we contact your present and previous Employers? Please identify any reason for not contacting your employers:	Yes  No
Only U.S. citizens or aliens who have legal right to work in the U.S. are eligible for employment.  Can you, upon employment, submit documentation verifying your legal right to work in the U.S. and your identity?  Proof of citizenship or immigration status will be required upon employment.	Yes  No
On what date would you be available for work?
Are you available to work: Full Time    Part Time    Night Shift    Temporary
Will you work overtime if asked?	Yes  No
Are there any hours, shifts or days you will not work?  If yes, please explain:	Yes  No
Have you ever pled guilty or "no-contest" to a crime, or been convicted of a crime? If yes, please explain: Answering "Yes" to this question does not constitute an automatic bar to employment.  Only those crimes which are substantially related to the position you are seeking will be considered.	Yes  No
In order to permit a check of your work and educational records, should we be made aware of any change of name or assumed name that you previously used?  If yes, identify names and relevant dates:	Yes  No

Account for all time periods including unemployment and military service.  List most recent jobs first.

1. Employer:   Employed From: To:

Address:   Telephone Number(s):  

Starting Salary: $   Final Salary: $     Job Title:     Supervisor:

Reason for Leaving:

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2. Employer:   Employed From: To:

Address:   Telephone Number(s):  

Starting Salary: $   Final Salary: $     Job Title:     Supervisor:

Reason for Leaving:

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3. Employer:   Employed From: To:

Address:   Telephone Number(s):  

Starting Salary: $   Final Salary: $     Job Title:     Supervisor:

Reason for Leaving:

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4. Employer:   Employed From: To:

Address:   Telephone Number(s):  

Starting Salary: $   Final Salary: $     Job Title:     Supervisor:

Reason for Leaving:

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5. Employer:   Employed From: To:

Address:   Telephone Number(s):  

Starting Salary: $   Final Salary: $     Job Title:     Supervisor:

Reason for Leaving:

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6. Employer:   Employed From: To:

Address:   Telephone Number(s):  

Starting Salary: $   Final Salary: $     Job Title:     Supervisor:

Reason for Leaving:

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Have you ever been dismissed or asked to resign from any employment?  If Yes, please explain:	Yes  No
Are you currently on "Lay-Off" Status and subject to recall?	Yes  No

 

Military Are you a veteran of the U.S. Military Service?	Yes  No
If Yes, what branch of Service? Beginning date and ending date of active duty:  From: To: Rank: Date of discharge from Military Service:

 

Education

Elementary School Name & Location:

Years Completed: grade 4 5 6 7 8    Diploma/Degree:

 

High School Name & Location:

Years Completed: grade 9 10 11 12    Diploma/Degree:

 

Undergraduate University/University Name & Location:

Years Completed: 1 2 3 4    Diploma/Degree:

 

Graduate/Professional Name & Location:

Years Completed: 1 2 3 4   Diploma/Degree:

 

References

Give the name, address and telephone number of three references who are not related to you and are not previous employers:

 

Special Skills and Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience

 

List professional, trade, business, or civic activities and offices held. 
You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, handicap or other protected status